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APACHE-II Score Correlation with Mortality and Length of Stay in an Intensive Care Unit Saad Ahmed Naved, Aga Khan University

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APACHE-II Score Correlation with Mortality and Length of Stay in an Intensive Care Unit Saad Ahmed Naved, Aga Khan University View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by eCommons@AKU eCommons@AKU Department of Anaesthesia Medical College, Pakistan January 2011 APACHE-II Score Correlation With Mortality And Length Of Stay In An Intensive Care Unit Saad Ahmed Naved, Aga Khan University Shahla Siddiqui Aga Khan University Fazal Hameed Khan Aga Khan University Follow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_anaesth Part of the Anesthesiology Commons Recommended Citation Naved,, S., Siddiqui, S., Khan, F. (2011). APACHE-II Score Correlation With Mortality And Length Of Stay In An Intensive Care Unit. Journal of the College of Physicians and Surgeons Pakistan, 21(1), 4-8. Available at: http://ecommons.aku.edu/pakistan_fhs_mc_anaesth/1 ORIGINAL ARTICLE APACHE-II Score Correlation With Mortality And Length Of Stay In An Intensive Care Unit Saad Ahmed Naved, Shahla Siddiqui and Fazal Hameed Khan ABSTRACT Objective: To correlate the APACHE-II score system with mortality and length of stay in ICU. Study Design: Cohort study. Place and Duration of Study: The Intensive Care Unit (ICU) of the Aga Khan University Hospital, Karachi, from May 2005 to May 2006. Methodology: All adult patients who were admitted in the ICU were included. APACHE-II score was calculated at the second and seventh days of admission in the ICU. Patients who were discharged alive from the ICU or died after first APACHE-II Score (at 2nd day) were noted as the primary outcome measurement. Second APACHE-II score (at 7th day) was used to predict the length of stay in the ICU. Pearson's correlation coefficient (r) was determined with significance at p < 0.05. Results: In the lowest score category 3-10, 27 out of 30 patients (90%) were discharged and only 3 (10%) died. Out of those 39 patients whose APACHE-II score was found in high category 31 - 40, 33 (84.6%) deaths were observed. This revealed that there might be more chances of death in case of high APACHE-II score (p=0.001). Insignificant but an inverse correlation (r = -0.084, p < 0.183) was observed between APACHE-II score and length of ICU stay. Conclusion: The APACHE-II scoring system was found useful for classifying patients according to their disease severity. There was an inverse relationship between the high score and the length of stay as well higher chances of mortality. Key words: APACHE-II. Outcome. Mortality. Length of stay. Intensive care unit. INTRODUCTION measurement is selected to generate the APS Due to limited health resources and an increase in the component of the APACHE-II score. If variable has not cost of health management, prognosis from the disease been measured, it is assigned zero points. The variables has become a very important area of health sciences.1 are, internal temperature, heart rate, mean arterial Assessment of medical treatment outcome was started pressure, respiratory rate, oxygenation, arterial pH, in 1863. Florence Nightingale was the first person who serum sodium, serum potassium, serum creatinin, addressed this issue.2 Many scoring systems have been haematocrit, white blood cells count and Glasgow coma developed for intensive care units. These scoring scale. Second component is age adjustment: From one systems provide gross estimate of mortality risks in to six points are added for patients older than 44 years intensive care units patients. The most frequently used of age. Third component of APACHE-II is chronic health scoring systems are, APACHE-II (acute physiology and evaluation. An additional adjustment is made for patients chronic health evaluation II), APACHE-III (acute with severe and chronic organ failure involving the heart, physiology and chronic health evaluation III), SAPS II lungs, kidneys, liver and immune system. (simplified acute physiological score II) and MPM II One of the limitations of these scoring systems is that (mortality probability model II).3,4 these systems basically reflect the population The APACHE-II and III scoring systems were developed characteristics and the medical culture of the country in which they were originally developed.5 Same problem by Knaus et al. in 1985 and 1991 respectively.2,4 The APACHE-II score consists of three components exists with APACHE-II. So before the application of (Table I). Acute physiology score (APS), the largest these scoring systems they should be tested in the local component of the APACHE-II score is derived from 12 medical environment. Literature available on this subject clinical measurements that are obtained within 24 in Pakistani context is very limited. This study was hours after admission to the ICU. The most abnormal designed to correlate the APACHE-II scoring system with mortality and length of stay in patients admitted in Department of Anaesthesia, The Aga Khan University Hospital, intensive care unit. Karachi. Correspondence: Dr. Saad Ahmed Naved, Flat No. 4, Block-26, METHODOLOGY PHA, Gulistan-e-Johar, Block-10, Karachi. This study was conducted in a 10-bed, general intensive E-mail: [email protected] care unit, at the Aga Khan University Hospital, Karachi, Received April 26, 2010; accepted December 15, 2010. using a multidisciplinary approach to patient care. 4 Journal of the College of Physicians and Surgeons Pakistan 2011, Vol. 21 (1): 4-8 APACHE-II score correlation with mortality and length of stay in an intensive care unit Table I: APACHE-II score and patient's outcome (n=253). APACHE II score Number of patients Patients discharged Patients died Observed mortality (%) Predicted mortality (%) 3-10 30 27 3 10% 11% 11-20 100 71 29 29% 35.5% 21-30 83 33 50 61% 70.3% 31-40 39 6 33 84.6% 91% > 40 1 0 1 100% 92% After approval by the institutional Research Ethics Eighty nine patients were aged under 45 years. Out of Committee, study was prospectively carried out from those 89 patients majority (67.4%) survived and were 10th May 2005 to 10 May 2006. All admitted medical discharged from the ICU. On the other hand, 71 patients and surgical (non-cardiac) patients aged 12 years or aged above 64 years, out of whom 25 (35.2%) survived above who remained in the intensive care unit for more while 46 (64.8%) died. Significant association (p=0.001) than 24 hours, were included in the study. Patients with of age with outcome was therefore revealed (Figure 1). incomplete set of physiological variables, post - CABG Mean APACHE-II score of the study patients was 20.84. patients and patients who stayed for less than 24 hours On the basis of APACHE-II score, the patients were in the ICU were excluded. Demographic data, indication divided into five groups. The first group patients had of ICU admission and presence or absence of any APACHE-II score of 3-10, second group had 11-20, chronic illness was recorded on a data collection form. third group had 21-30, fourth group had 31-40 and fifth At the completion of first 24 hours after the admission in group scored > 40. the ICU, APACHE-II score was calculated by using 12 physiological variables. Points were allocated to the worst values of each variable as per protocol of APACHE-II scoring system calculation. Age and chronic health were also assigned points in the similar manner. Sum of A, B and C constituted APACHE-II score for a patient. Glasgow coma scale was used to assess the conscious levels. In post-surgical patients, who were still under the effect of anaesthesia, assessment was made after the patient had overcome the anaesthetic effects. For intubated patients, this score was calculated considering their ability to understand, regardless of speech. Final outcome of the patient (shift out or death) and total length of ICU stay was also recorded. All the data recorded on a proforma of APACHE-II score by the Figure 1: Association of age with outcome (n = 253). primary investigator. Significant association between higher age and expiry of patients 2 Statistical analysis was performed through SPSS (χ = 17.28, p=0.002). version-10.0. Numeric response variables including age In the first group, there were 30 patients. Out of them, 27 and length of ICU stay were presented as mean ± SD. (90%) were discharged and 3 died (10%). There were All categorical variables including APACHE-II score, age 100 patients in second group; 71 (71%) were groups and outcome in terms of either death or discharged and 29 (29%) died. Eighty three patients discharge were presented by frequencies and were in group III, 33 patients (39%) were discharged, percentages; chi-square test was applied to compute while 50 patients (61%) died. Group IV had 39 patients; significance of association of APACHE-II score and age 33 (84.6%) died and only 6 (15.4%) survived. There was with patients' outcome. Pearson's correlation coefficient only one patient in group V, with APACHE II score of was computed to determine correlation of APACHE-II > 40, and he died (100%). This revealed that there might with age and length of hospital stay. A p-value of less be more chances of death in case of high APACHE-II than 0.05 was considered statistically significant. score (p=0.001, and more chances of getting out from the ICU in case of low APACHE scores (Table II, RESULTS Figure 2). Mean ICU stay in the patients who expired was 6.65 (± 4.76 ranging from 1 to 20) days while in Two hundred and fifty three patients were included in the those who survived and discharged was 7.34 (±7.01 study; 124 were males and 129 were females. One ranging from 1 to 51) days.
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